AB0286 RETENTION RATE OF BIOLOGIC DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS IN PATIENTS WITH RHEUMATOID ARTHRITIS WITH DECREASED KIDNEY FUNCTION: RESULTS FROM THE IORRA COHORT
Authors: T. Higuchi, E. Tanaka, E. Inoue, M. Abe, K. Saka, E. Sugano, N. Sugitani, H. Yoko, M. Ochiai, R. Yamaguchi, K. Ikari, Y. Hisashi, M. Harigai
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> We previously reported that rheumatoid arthritis (RA) patients with chronic kidney disease (CKD) were at increased risk of failure to achieve remission and of occurrence of hospitalized infections [1]. Although biologic disease-modifying anti-rheumatic drugs (bDMARDs) are a promising treatment option, their effectiveness and safety for this population have not been fully evaluated to date. <h3>Objectives</h3> To determine the optimal bDMARD selection for treatment of RA patients with decreased kidney function, we compared the retention rates of patients receiving tumor necrosis factor inhibitor (TNFi), interleukin-6 inhibitor (IL-6i), and abatacept (ABT) in RA patients using data from the IORRA cohort, the real-world data registry of Japanese RA patients. <h3>Methods</h3> Renal function was calculated using the Japanese versions of the equations for estimated glomerular filtration ratio (eGFRcr). Deceased renal function was defined as eGFR<sub>Cr</sub> &lt;60 mL/min/1.73m<sup>2</sup>. Among RA patients enrolled in the IORRA cohort between 2003 and 2020, data from patients with decreased kidney function who started bDMARDs were extracted. Renal function and use of bDMARDs by the extracted patients were identified in their medical records. Reasons for discontinuation were classified as ineffectiveness, adverse events caused by bDMARDs, or other reasons. Retention rates due to ineffectiveness or adverse events caused by TNFi (adalimumab or adalimumab biosimilar [ADA], certolizumab pegol [CZP], etanercept or etanercept biosimilar [ETN], golimumab [GLM], infliximab or infliximab biosimilar [IFX]), IL-6i (tocilizumab [TCZ], sarilumab [SAR]) and ABT spanning 36 months were calculated using the Kaplan-Meier method, and adjusted hazard ratio [aHR] of discontinuation of each bDMARD was calculated using the Cox proportional hazard model, with adjustments for age, sex, disease duration, clinical disease activity index (CDAI), methotrexate (MTX)/ prednisolone (PSL) use, and previous bDMARD use at baseline. <h3>Results</h3> A total of 238 treatment courses administered to 191 patients with decreased renal function were included. Median eGFR<sub>Cr</sub> was 52.5 mL/min/1.73m<sup>2</sup> (interquartile range: 43.3–57.4). The numbers of bDMARD users were as follows: TNFi, 143 (ADA, 15; CZP, 5; ETN, 67; GLM, 30; IFX, 26); IL-6i, 59 (all were TCZ); and ABT, 36, respectively. ABT users were older than IL-6i users, and TNFi users had higher eGFR<sub>Cr</sub> and a higher proportion of MTX and previous DMARD use than the other groups. Sex, seropositivity, CDAI, health assessment questionnaire, and the proportion of PSL use were similar between groups. The retention rates at 36 months were 59.9%, 72.9%, and 61.7% for TNFi, IL-6i, and ABT, respectively. aHR of discontinuation when TNFi served as reference was 0.60 (95% confidence interval: 0.32–1.10) for IL-6i, and 0.85 (95% confidence interval: 0.44–1.64) for ABT. <h3>Conclusion</h3> Because the retention rate of IL-6i was numerically high compared with TNFi and ABT in this study, IL-6i may offer a treatment advantage in RA patients with decreased renal function. <h3>Reference</h3> [1] Higuchi et al. Mod Rheumatol. 2022;32(5):875–884. <h3>Acknowledgements</h3> We would like to thank Editage (www.editage.com) for English language editing. This work was supported by a research grant from the Ministry of Health, Labour and Welfare (20FC1044). <h3>Disclosure of Interests</h3> Tomoaki Higuchi: None declared, Eiichi Tanaka Speakers bureau: AbbVie Japan GK; Asahi Kasei Corp.; Astellas Pharma Inc.; Ayumi Pharmaceutical Co.; Chugai Pharmaceutical Co., Ltd.; Eisai Co., Ltd.; Eli Lilly Japan K.K.; GlaxoSmithKline K.K.; Kyowa Pharma Chemical Co., Ltd.; Janssen Pharmaceutical K.K.; Mochida Pharmaceutical Co., Ltd.; Pfizer Japan Inc.; Takeda Pharmaceutical Co., Ltd.; and Teijin Pharma Ltd., Eisuke Inoue Speakers bureau: Bristol Myers Squibb Co., Ltd.; Pfizer Japan Inc.; Nippontect systems Co., Ltd.; RCR Co., Ltd., Mai Abe: None declared, Kumiko Saka: None declared, Eri Sugano: None declared, Naohiro Sugitani: None declared, higuchi yoko: None declared, Moeko Ochiai: None declared, Rei Yamaguchi: None declared, Katsunori Ikari Speakers bureau: Asahi Kasei Corp.; Astellas Pharma Inc.; AbbVie Japan GK; Ayumi Pharmaceutical Co.; Bristol Myers Squibb Co., Ltd.; Chugai Pharmaceutical Co., Ltd.; Eisai Co., Ltd.; Eli Lilly Japan K.K.; Janssen Pharmaceutical K.K.; Kaken Pharmaceutical Co. Ltd.; Mitsubishi Tanabe Pharma Co.; Pfizer Japan Inc.; Takeda Pharmaceutical Co. Ltd.; Teijin Pharma Ltd.; and UCB Japan Co. Ltd., Yamanaka Hisashi Consultant of: CorEvitas LLC, Masayoshi Harigai Speakers bureau: AbbVie Japan GK; AstraZeneca K.K.; Ayumi Pharmaceutical Co.; Boehringer Ingelheim Japan Inc.; Bristol Myers Squibb Co., Ltd.; Chugai Pharmaceutical Co., Ltd.; Eisai Co., Ltd.; Eli Lilly Japan K.K.; GlaxoSmithKline K.K.; Gilead Sciences Inc.; Janssen Pharmaceutical K.K.; Kissei Pharmaceutical Co., Ltd.; Nippon Kayaku Co., Ltd.; Nippon Shinyaku Co., Ltd.; Novartis Japan; Pfizer Japan Inc.; CIMIC Holdings Co., Ltd.; Mitsubishi Tanabe Pharma Co.; Teijin Pharma Ltd.; and UCB Japan Co. Ltd., Consultant of: AbbVie; Boehringer-Ingelheim; Bristol Myers Squibb Co.; Kissei Pharmaceutical Co., Ltd.; and Teijin Pharma Ltd., Grant/research support from: AbbVie Japan GK; Asahi Kasei Corp.; Astellas Pharma Inc.; Ayumi Pharmaceutical Co.; Boehringer Ingelheim Japan, Inc.; Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Daiichi-Sankyo, Inc., Eisai Co., Ltd.; Kaken Pharmaceutical Co., Ltd.; Kissei Pharmaceutical Co., Ltd.; Mitsubishi Tanabe Pharma Co.; Nippon Kayaku Co., Ltd.; Sekisui Medical; Taisho Pharmaceutical Co., Ltd.; and Teijin Pharma Ltd.